Li Yan, Mumtaz Sehreen, Baig Hassan Z, Mira-Avendano Isabel, Wang Benjamin, Rojas Carlos A, Stowell Justin T, Lesser Elizabeth R, Borkar Shalmali R, Majithia Vikas, Abril Andy
Division of Rheumatology, Mayo Clinic, Jacksonville, FL 32224, USA.
Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.
Diagnostics (Basel). 2024 Nov 30;14(23):2702. doi: 10.3390/diagnostics14232702.
To investigate the effect of mycophenolate mofetil (MMF) and rituximab (RTX) on pulmonary function test (PFT) results in a mixed cohort of patients with connective tissue disease-associated interstitial lung disease (CTD-ILD), longitudinally followed up for 1 year in a single academic center. Patients with CTD-ILD were identified in electronic medical records from 1 January 2009 to 30 April 2019. Prescribed MMF and RTX doses, dosage changes, and therapy plans were analyzed individually with improvement in PFT outcomes determined using multivariable linear regression models during 12-month follow-up. Forty-seven patients with CTD-ILD, treated with MMF, RTX, or both, were included. Patients on combined MMF and RTX had worse PFT outcomes at baseline compared with patients on monotherapy. Substantial improvement was observed among all PFT outcomes from baseline to 12 months, regardless of medication dosage or therapy plans. The diffusing capacity of the lungs for carbon monoxide (DLCO) worsened by an average of 7.21 mL/(min*mmHg) (95% CI, 4.08-10.33; < 0.001) among patients on RTX compared to combined therapy. Patients on higher doses of MMF at baseline experienced an average increase of 0.93 (95% CI, 0.04-1.82) units in DLCO from baseline to 6 months ( = 0.04) and a 2.79% (95% CI, 0.61-4.97%) increase in DLCO from 6 to 12 months ( = 0.02) within patients on concurrent RTX at 6-month follow-up. The treatment of CTD-ILD with MMF and/or RTX was associated with overall improvement in PFT outcomes. Combined therapy resulted in significant improvements in DLCO compared with monotherapy. Higher doses of MMF also provided greater improvements in DLCO.
为了研究霉酚酸酯(MMF)和利妥昔单抗(RTX)对结缔组织病相关间质性肺病(CTD-ILD)混合队列患者肺功能测试(PFT)结果的影响,在单个学术中心进行了为期1年的纵向随访。从2009年1月1日至2019年4月30日的电子病历中识别出CTD-ILD患者。分别分析MMF和RTX的处方剂量、剂量变化及治疗方案,并在12个月的随访期间使用多变量线性回归模型确定PFT结果的改善情况。纳入了47例接受MMF、RTX或两者治疗的CTD-ILD患者。与单药治疗患者相比,联合使用MMF和RTX的患者在基线时PFT结果更差。从基线到12个月,所有PFT结果均有显著改善,无论药物剂量或治疗方案如何。与联合治疗相比,接受RTX治疗的患者一氧化碳弥散量(DLCO)平均恶化7.21 mL/(min*mmHg)(95%CI,4.08-10.33;P<0.001)。基线时接受较高剂量MMF治疗的患者,在6个月随访时同时接受RTX治疗的患者中,从基线到6个月DLCO平均增加0.93(95%CI,0.04-1.82)单位(P=0.04),从6个月到12个月DLCO增加2.79%(95%CI,0.61-4.97%)(P=0.02)。MMF和/或RTX治疗CTD-ILD与PFT结果的总体改善相关。与单药治疗相比,联合治疗使DLCO有显著改善。较高剂量的MMF也使DLCO有更大改善。